P20S07: Migraine prophylaxis
Bottom line: Information on migraine prophylaxis was used to
justify the management of the patient (justify the use of Epival drug). There were no information-related patient
health outcomes.
Level 1 outcome (situational relevance): On November 10, 2008, P20 did a search at work, by themselves, and
after an encounter with a patient. They retrieved four information hits about migraine prophylaxis. The reported search objectives were: to address a clinical question, to
share information with a patient and a caregiver (the spouse), to exchange
information with another health professional, and to plan, manage or coordinate tasks with this health professional. “He [the patient, a 79 years old male] had chronic
daily headaches for probably most of his life. […] His headaches were medication overuse
headaches. He’s been using Acetaminophen and Codeine daily for years. […] I decided to
use Divalproex before I looked in the eCPS [to replace acetaminophen and
codeine, and prevent headaches]. [...] My clinical question was for dosing and
monitoring [Divalproex], […] [and my search] did answer the
monitoring parameters. […][I did] the counselling in the end [with the
patient], of how to use the drug, what side effects
to look for, etc. […] In regards to the recommendation to the
physician, [I exchanged the information on] dosing, and
monitoring.” According to P20, the information from e-Therapeutics+
was in agreement and equally relevant as the information from another
electronic resource (RX-Files). “[After my
search in e-Therapeutics+], I didn’t really have a clear dose for
migraine prophylaxis. […] RX Files was really easy to open to the
migraine prophylaxis pages and compares all the agents with more information.”
Level 2 outcome (cognitive impact): Four hits were associated with a report of positive cognitive impact (see table). Regarding
learning and reminder, P20 stated: “[Some information reminded me, but others I
did not know]. Like, [in the Warnings section], I knew you need
liver function test. I know that it’s risks for pancreatitis. But, you know, I
might not have remembered all the other little details that are there. […][In the Adverse effects section too], there’s a lot
of stuff listed there so I think there’s new bits of information there that I
didn’t realize before. This is the first time I have actually been recommending
it [Epival], [as
well as] developing the monitoring plan. So there’s
stuff that I haven’t seen before necessarily.”
Retrieved
information hits:
1)e-Therapeutics+ (CIRT): eCPS Tab – Keyword: Divalproex – Divalproex sodium – Epival Monograph – Indications (P20S07H01)
2) e-Therapeutics+ (CIRT): eCPS Tab – Keyword:
Divalproex – Divalproex sodium – Epival Monograph – Warnings (P20S07H02)
3) e-Therapeutics+ (CIRT): eCPS Tab – Keyword:
Divalproex – Divalproex sodium – Epival Monograph – Adverse
effects (P20S07H03)
4) e-Therapeutics+ (CIRT): eCPS Tab – Keyword:
Divalproex – Divalproex sodium – Epival Monograph – Supplied (P20S07H04)
Level 3 outcome
(information use): Information on the migraine prophylaxis was
retrieved, and used to justify the management of the patient (information used as presented in e-Therapeutics+). “I did use the dose and print the
prescription out for the doctor, [...] I actually wrote a prescription for the
doctor to sign with some of my recommendation. [...] Directly from the search
that I did, it helped me to develop a monitoring plan [...] I definitely spoke to the doctor first and
then, the patient. [...] So I was just, basically, obtaining drug
information […] [to justify] that the drug
could be safe in this patient. He had tried Beta Blockers before. He had tried
tricyclic anti-depressants before. He had tried calcium channel blocker before.
He had never tried an anticonvulsant. I decided that Divalproex may be the best
for him because of drug coverage. I know Gabapantin is not a covered benefit.
Topamax was not a covered benefit, but Epival was. […] So it was
important to justify the decision of what I had already decided to do.”
Level 4 outcome (patient health): Regarding patient
health, P20 reported that there were no information-related outcomes. “I followed up [over three months] in terms
of making sure that he’s ok on the drug, but there hasn’t been a big change in
his headache [yet].”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information Manage patient care |
Learned something Reminded something Confirmed |
Justify choice |
No outcome |